BlackBerry Consumer Order Form

Data Card On-Line Order
Form

Verizon
Novatel V620

Cingular
Sony Ericsson GC83

Use the form below to enter your Data Card order. Every Data Card eAccess ships is fully activated and ready to use right out of the box! All Data Card purchases must be accompanied with an airtime contract for wireless data service. This form gives us all the information we need to complete the airtime contract and fax it to you for your signature to complete your order.

Coverage tools to make sure your device will have service:

Check Cingular Coverage HERE	Check Verizon Coverage HERE
Contact eAccess for a Detailed Coverage Analysis HERE



Verizon Novatel V620	$199*	* Price requires minimum data activation through eAccess

Cingular Sony Ericsson GC83	$149*	* Price requires minimum data activation through eAccess $100 Mail in Rebate for a Limited Time!

Each unit comes with: software & user manual

Select Verizon Card Model:		Select Data Plan:
	Qty
Area Code and City Requested ( i.e. 312, Chicago):

Select Cingular Card Model:		Select Data Plan:
	Qty
Area Code and City Requested ( i.e. 312, Chicago):

Bill To Information (Home Residence):

Name
Home Address		Apt#

City

Zip

Home Phone	(Must be a land line number)
Work Phone
Fax
	* Your Airtime Contract will be faxed to this number.
E-mail
	* Important, order tracking information will be Emailed to this address!

Ship To Information:

Same as Bill To:

Name
Company
Address		MS#

City

Zip

Required Credit Information:

Your SSN

Drivers License #

Birth Date (xx-xx-xx)

Payment:

We accept Visa, MasterCard, American Express and your companies purchase orders with prior credit approval.

Credit Card Type

Credit Card Number

Card Exp. Date

- or -

Company P.O.*

*Requires company credit application be on file
(Download Credit Application)

Shipping:
Preferred Shipping Method
* All orders ship from Chicago, IL FOB Destination * Devices are provisioned and shipped within 24 hours of receipt of airtime contract

Comments:
Please indicate any additional requirements or preferences

Have any questions? For additional information, server software or services
Email us at: sales@eAccessinc.com
or call us at: (847) 991-7190

Click HERE to return to our Home Page without ordering.